What is a Periodontal Abscess?

A periodontal abscess is an abscess that comes from the gum and not the tooth. It is really important that we know the origin of the abscess, since the treatment for a tooth abscess and a gum abscess is completely different. Your dentist will consider a number of things in making the diagnosis and deciding on the most appropriate treatment.

What Causes it?

An abscess forms when the balance between your body and the bacteria in a periodontal pocket (area of bone loss next to your tooth) is upset. This may be due to an increase in the number of bacteria, or if particularly nasty (‘virulent’) types of bacteria get introduced into the mix. It can also occur because your body’s resistance is lowered such as from stress, tiredness, illness or infection.

A blockage in a periodontal pocket may cause a collection of pus to form, or more rarely the impaction of a foreign object (even a bit of calculus).

What are the Signs and Symptoms of a Periodontal (Gum) Abscess?

Tenderness. The area is tender to touch- more so, when moving the tooth sideways (unlike a tooth abscess which hurts more to press down or bite on).

Mobility. The tooth maybe slightly mobile due to the build up of pus and the amount of attachment loss.

Pain. The greater the build up of pressure from the pus forming, the more pain you are likely to have.

Bad taste. If the abscess drains, the pain will largely go but you still may be able to see pus at the gum margin or have a pretty bad taste in your mouth.

Swelling. There is also likely to be some swelling and redness in the gum next to the affected tooth.

An X-ray from your dentist is likely to shows evidence of periodontal disease and significant bone loss, creating a (periodontal) pocket next to the tooth. The tooth will often respond to vitality testing (things we do to check the nerve is alive inside)- such as applying a cold spray or using a small electrical current (known as an electric pulp test), unlike a tooth abscess which results from the nerve having died.

How is it Treated?

The build up of pus, if untreated will eventually find a place to discharge, either up through the pocket, around the tooth or out through the side of the gum next to it. This may have been happening already without you really noticing anything except a bit of a bad taste occasionally and maybe your tooth was slightly loose. If the path along which the pus is draining suddenly becomes blocked, then the tooth can become sore all of a sudden with the increase in pressure.

To treat the problem, the area is made numb by the dentist, the pus drained and the pocket cleaned of any plaque and calculus that has built up there. An ultrasonic scaler may be used to flush out all the rubbish and some dentists would irrigate down into the pocket with an antimicrobial mouthwash such as chlorhexidine or with saline. There is likely to be a lot of bleeding as the area is almost always inflamed.

This treatment will normally clear things up pretty rapidly and provide relief of the pain, but the real issue generally still remains. That is, that the bone loss that has occurred has created an area under the gum which is very difficult to keep clean at home. Depending on just how much bone has been lost or if abscesses keep re-occurring, it might be that you need further periodontal treatment or to think about having the tooth extracted.

If the tooth has very little bony support holding it in and is very loose, the most sensible option may be to remove the tooth there and then if the dentist is able to get you numb. Other treatment may temporarily improve the situation but if the prognosis is hopeless- the tooth may be better off in the bin.Your dentist will be able to advise you on the best course of action after examining the tooth and seeing an xrays of it.

Antibiotics may be needed if:

A number of periodontal abscesses happen all at the same time

The swelling is considerable

The dentist can’t get you numb

The pus cannot be drained

The infection starts spreading (your glands are up, you feel unwell and often have a temperature)